First blood work after adding testosterone to HCG solo treatment

[paco]

A bit of background on my treatment here:
https://www.excelmale.com/forum/sho...lus-HCG-to-preserve-fertility&p=8008#post8008

I just had my first round of follow up blood work since starting TRT. Dr. Lipshultz and I will review the labs Wednesday. I will post the results after they are available. However, I have two questions that will help me to be prepared for Wednesday's appt.

First question: I split my dose up into twice a week injections, taking 80 mg Monday morning and 70 mg Thursday evening. My blood work was taken Wednesday morning, fasted. I take 500 IUs of HCG M/W/F mornings, including just before my recent blood work. Within approximately what range should be testosterone levels be, ideally, at that time? I know that my blood levels should be somewhat "steady state" at this point, but there is surely some expected variability, so what would be too high or too low at this point?

Second question: 7 weeks ago, I came down with appendicitis. (Needles to say, I was miserable.) Although my appendix ruptured, the doctor was able to treat it "conservatively" (i.e., without surgery) by putting me on IV antibiotics for a day followed by another 10 days of antibiotics and pain killers. Altogether, I was out of commission for a total of three weeks, at which time my appetite was fully recovered, and I was able to start walking further than just from room to room in my house. I lost 8 pounds, some of it fat but some it surely muscle, as my strength was down quite a bit and it's still down after being back in the gym for three weeks. I returned to the gym one week later, at the four week mark, with light weights. My question is, is it possible that my blood work would still be negatively affected by appendicitis that happened 7 weeks ago but impacted me for several weeks after that?

Thanks for the help!

 

[bruin]

Somewhat of a general question, just seeking some clarification about blood draw and IM administrations. I have a current order for a draw but just noticed they want me to wait 5 days after last IM. My rx is dose is 100mg weekly, but I have split it in two does throughout the week/Bi-Test (cyp 200mg/prop).

Un less I missed something, have not come across timing a draw in relation to maintaining the regimen.
Duane

 

[Nelson Vergel]

Duane: If you are injecting 50 mg twice per week, your blood level of testosterone will fluctuate little. This makes timing of blood draw less relevant. I would just have your blood drawn right before you inject again. But I doubt that it would matter much.

 

[Nelson Vergel]

Paco

Sorry to hear about your appendicitis.

Your total testosterone most probably will be over 600 ng/dL, although we are all different and it is hard to predict.

Unless you were on strong pain killers that may have changed your liver metabolism, you should not expect your T blood level to drop dramatically because of your recent appendicitis.

 

[paco]

Thanks, Nelson! I will post again after today's appt.

 

[paco]

Blood work results

So, I just received all of my blood test results from Labcorp with the exception of the estradiol sensitive test, which is apparently “pending”. As a reminder, my regimen for the last 6 weeks has been 150 mg/week, split up into two injections/week, HCG 500 IUs 3 times/week and 100 mg MRM micronized pregnenolone per day.

Before that I was on the same regimen, but at 200 mg of testosterone injected once per week. At the previous dose, I was tired, had interrupted sleep and little to no improvement in libido, spontaneous erections or mood. HOWEVER, at the new dose for the last 6 weeks (described above), all of that seems to be changing for the better. I’m finally excited about life, and feeling capable and loving again – like my old self! I’m guessing it just gets better from here.

Does anyone see anything here I should be aiming to address?

ps I will post my estradiol results when they become available as well. By the way, the doctor did not order a free testosterone test – I’m not sure why.


Cholesterol, Total - 270 mg/dl (100-199)
Tricglycerides – 73 mg/dl (0-149)
HDL – 60 mg/dl (>39)
VLDL Calculated – 15 mg/dl (5-40)
LDL Calculated – 195 mg/dl (0-99)
Testosterone, Total – 1102 ng/dl (348-1197)
LH - .1 mIU/mL (1.7-8.6)
FSH - <.2 mIU/mL (1.5-12.4)
DHT – 106 (30-85)
DHEA-S – 295 ug/dL (102-416)
Prolactin – 10.5 ng/mL (4.0-15.2)
IGF-1 - 168 ng/mL (83-233)
Hemoglobin – 16.6 g/dL (12.6-17.7)
Hematocrit – 48.3% (37-51%)
SHBG – 34.6 nmol/L (16.5-55.9)

 

[Nelson Vergel]

Paco: Nice blood work! (Don't waste money on LH and FSH, though). I would love to see sperm quality tests next time just to see if you would have the same results that Dr Lipshultz has reported.

 

[paco]

Paco: Nice blood work! (Don't waste money on LH and FSH, though). I would love to see sperm quality tests next time just to see if you would have the same results that Dr Lipshultz has reported.

Yeah, I still can't figure out why doctors choose to test LH and FSH while on testosterone and/or HCG.

And yes, the spermanalysis results are very important here! Duh!

Dr. Lipshultz said he is very happy with these results, and we should have no problems getting pregnant, based on these numbers. At first, he had suggested we try adding FSH or adding clomid to the regimen to facilitate natural production of FSH, but after that he retracted and said we didn't need either one. I trust him, given that fertility is where his expertise is most apparent.

Volume - 3 ml (1.5-5.0; WHO recommends more than 2.0)
Concentration - 38 M/mL (60-120; WHO recommends more than 20)
Motility - 50% (60-80; ; WHO recommends 50 and above)
Forward progression 2.0 (2.5-3.5)
Total count - 114M (90-600; WHO recommends 40 and above)
Total motile - 57M (54-480)

 

[paco]

ps The above results are very similar to those from before I began any type of treatment, including clomid, HCG or testosterone. The following were from a different lab in January 2013.

Volume - 3.1 ml (1.5-5.0)
Concentration - 51 M/mL (>=20)
Motility - 43% (>50%)
Total motile - 68M

 

[Nelson Vergel]

Wow..thanks for the update. It is good to see sperm quality numbers for men on TRT+HCG

 

[paco]

I expect the sperm parameters to improve further as the inflammation from appendicitis fully resolves. The surgeon tells me that will take another 5-6 weeks from now. I believe that the elevated total cholesterol and LDL cholesterol figures (as well as my ongoing awareness of my appendicitis) are indicators of this ongoing inflammation. I will post spermanalysis results again in 3 months.

 

[paco]

Ok, my estradiol test results just came in. So, here are the full recent labs, including the spermanalysis.

Estradiol, sensitive - 40 pg/mL (3-70)
Cholesterol, Total - 270 mg/dl (100-199)
Tricglycerides – 73 mg/dl (0-149)
HDL – 60 mg/dl (>39)
VLDL Calculated – 15 mg/dl (5-40)
LDL Calculated – 195 mg/dl (0-99)
Testosterone, Total – 1102 ng/dl (348-1197)
LH - .1 mIU/mL (1.7-8.6)
FSH - <.2 mIU/mL (1.5-12.4)
DHT – 106 (30-85)
DHEA-S – 295 ug/dL (102-416)
Prolactin – 10.5 ng/mL (4.0-15.2)
IGF-1 - 168 ng/mL (83-233)
Hemoglobin – 16.6 g/dL (12.6-17.7)
Hematocrit – 48.3% (37-51%)
SHBG – 34.6 nmol/L (16.5-55.9)

Volume - 3 ml (1.5-5.0; WHO recommends more than 2.0)
Concentration - 38 M/mL (60-120; WHO recommends more than 20)
Motility - 50% (60-80; ; WHO recommends 50 and above)
Forward progression 2.0 (2.5-3.5)
Total count - 114M (90-600; WHO recommends 40 and above)
Total motile - 57M (54-480)

 

[Nelson Vergel]

Paco

Nice numbers except for LDL cholesterol.

 

[paco]

Yeah, I'm not sure what's going on there. I would presume that is either from the inflammation or from TRT. I have heard TRT can elevate LDL but I haven't had the chance to research.

 

[paco]

I just had another sperm analysis done with another lab. Results will vary among labs, but still, I'm pretty happy about this! HCG seems to be doing the trick.

Volume: 3.7 ml (1.5-5.0; WHO recommends more than 2.0)
Concentration: 112 million/mL Concentration - (60-120; WHO recommends more than 20)
Motility: 51.85% (60-80; ; WHO recommends 50 and above)
Total motile sperm: 214.87 million!!! (54-480)

ps I have researched cholesterol parameters, and total cholesterol and total LDL (which is the sum of the "good", fluffy LDL particles and the "bad", smaller, denser LDL particles) are very poor indicators of cardiovascular health. The more important parameters are HDL, triglycerides, and VLDL. I'm looking really good in all of those, so I'm not the least bit concerned.

 

[Nelson Vergel]

Paco

Congrats man on the spem and lipid results. It is good to validate Lipshultz' data!

 

[paco]

Should I be concerned about free T being over the top of the range?

Update and question: Should I be concerned about free T being over the top of the range, if I’m not having negative side effects?

For the sake of trying all of my options, I just tried 4 weeks at a reduced dose of testosterone. I reduced the dose from 75 mg twice per week (at which I was feeling great – improved energy, focus, confidence, sociability, mod, libido and spontaneous erections) to 60 mg twice a week (at which I wasn’t feeling so great). Although I planned to increase the dose back to 75 mg twice per week so I would get back to feeling better, I thought it would be good to do some labs at 60 mg twice per week to see how things were looking. Those results follow. Note from my previous results that all other blood work seems to look good (although free T was not measured), even at the higher dose.

So, I am just curious if a high free T level is problematic, if all else is looking and feeling good? Also, any thoughts on whether I should try to get cortisol up and how to best go about doing so?


Total T - 1086 ng/dL (348 – 1197)
Free T - 38.0 pg/mL (8.7 - 25.1)
DHEA - 295.7 ug/dL (102.6 - 416.3)

Salivary Cortisol, 7 am – 0.166 ug/dL (0.025 - 0.600)
Salivary Cortisol, 12 pm – 0.065 ug/dL (<0.010 - 0.330)
Salivary Cortisol, 4 pm – 0.016 ug/dL (0.010 - 0.200)
Salivary Cortisol, midnight - ,0.010 ug/dL (<0.010 - 0.090)

 

[Vettester Chris]

Paco, I'm personally concerned with your cortisol results. I will attach your circadian profile to give you a better illustration. Many experts in the field of adrenal treatment, like Dr. Lam, would like to see your AM number towards the top of the reference range, then more mid-range throughout the day, and maybe tapering towards the lower end of the range at night.

I think more investigation on the matter is worth pursuing, that's just my .02 ...

 

[paco]

Thank you, Chris. I'm guessing the free T doesn't seem too concerning to you?

Yes, I have been working on cortisol as well for about 6 months. It seems that I am always somewhat low according to several 4-pt. cortisol saliva tests I have had so far. That may explain some of my mood, libido and energy issues. To date, my doctor has been trying pregnenolone orally, first at 50 mg daily and then at 100 mg daily (McPherson Labs brand, then MRM brand, both of which felt the same), with little change in cortisol or DHEA to speak of. (I think it's possible that since starting TRT a few months ago, that some of the pregnenolone may now be shunted to DHEA as my DHEA levels have hardly changed at all since starting TRT.)

Other options I'm considering...
1) Pregnenolone cream (maybe absorption would be better?)
2) Add DHEA (to whatever extent, if any, oral preg is being shunted to DHEA, then maybe this would leave more to be converted to cortisol?)
3) Adrenal cortex extract (not sure which brand or dose would be best)
*4) Licorice root

*I had tried a couple of adaptogens, including rhodiola and ashwaghanda, but both seemed to actually lower my cortisol within a few hours of taking them. So, licorice root seems to be the only adaptogen that might be a good fit for someone like me.

 

[Vettester Chris]

Paco, your free test is sitting at 3.5%. Just means your SHBG (and possibly albumin) are sitting pretty low. This is just relevant to your total serum. So, if you get your serum drops down to 700ng/dl you should come in/around the 24.5pg range, +/- a little, as free & bio will fluctuate with SHBG and albumin as noted. You indicated that cutting your dosage doesn't provide you the same well being as the higher levels. Possibly other variables will contribute to this, e.g., your cortisol, which will also have an impact on your thyroid & T3 (in conjunction with ATP) working effectively in the body.

Have you taken any other adrenal related labs (ACTH, Aldosterone, Renin)? Any issues with the electrolytes, i.e., sodium, potassium? Can you refresh me on how your thyroid numbers look? Isocort has been the best going adrenal cortex product out there IMO, but they stopped making it. I should have got more when I had a chance, as bottles are selling for more than $100 on EBay.

HC therapy could be an option, you might talk to your physician. Also, do some research on the Circadian T3 Method. There's some info on it at STTM.com. I was doing it prior to Isocort and it seemed pretty effective. Whatever course you take get with a good physician that can help treat you effectively.